Patients In Acute Care Setting Research Articles

Person-Centered Communication Between Health Care Professionals and COVID-19-Infected Older Adults in Acute Care Settings: Findings From Wuhan, China.

ObjectivesThe current study aims to explore person-centered communication between health care professionals and COVID-19 infected older patients in acute care settings.MethodsThe current qualitative study explored the communication between professionals and COVID-19 infected older adults in the acute care setting through two rounds of interviews with physicians and nurses who provided direct care and treatment for COVID-19 infected older patients in Wuhan, China. We explored the possibilities and significance of facilitating effective communication despite multiple challenges in the pandemic. Conventional content analysis was adopted to analyze the rich data collected from our participants.ResultsIt is possible and necessary to initiate and sustain person-centered communication despite multiple challenges brought by the pandemic. The achievement of person-centered communication can play significant roles in addressing challenges, building mutual trust, improving quality of care and relationships, and promoting treatment adherence and patients’ psychological wellbeing.DiscussionIt is challenging for healthcare professionals to provide care for COVID-19 infected older adults, especially for those with cognitive and sensory impairment, in acute care settings. Facilitating person-centered communication is a significant strategy in responding to the pandemic crisis and a core element of person-centered care.

Exposure, Relaxation, and Rescripting Therapy for Trauma-Related Nightmares With Psychiatric Inpatients: A Case Series

Research has shown that posttraumatic stress disorder (PTSD) is a highly prevalent diagnosis for psychiatric patients, yet individualized care and treatment is limited in the inpatient acute care sector. Two case studies are presented which examine the use of Exposure, Relaxation, and Rescripting Therapy (ERRT) for chronic trauma-related nightmares, within a private acute care inpatient psychiatric hospital setting. ERRT is empirically supported with efficacy for veteran and civilian populations, however no research to date has been conducted with psychiatric inpatients. Two participants diagnosed with PTSD, suffering distressing trauma-related nightmares, completed ERRT over three sessions during their psychiatric hospital admission, with the aim of reducing the frequency and severity of nightmares and related psychological symptoms. PTSD, depression, sleep quality and quantity, and nightmare frequency and related distress, were measured pre-treatment, during treatment, and follow-up at one, 3 and 6 months. Only one participant reported ongoing nightmares by the third week of the intervention, with both participants reporting an absence of nightmares at the one and 3-month follow-ups, but mixed results by the 6-month follow-up. One participant also reported a reduction in PTSD symptoms and a mild improvement in depression. The results offer some preliminary support for the provision of ERRT for the treatment of trauma-related nightmares for psychiatric inpatients.

New predictive models for falls among inpatients using public ADL scale in Japan:A retrospective observational study of 7,858 patients in acute care setting.

AimMost predictive models for falls developed previously were awkward to use because of their complexity. We developed and validated a new easier-to-use predictive model for falls of adult inpatients using easily accessible information including the public ADL scale in Japan.MethodsWe retrospectively analyzed data from Japanese adult inpatients in an acute care hospital from 2012 to 2015. Two-thirds of cases were randomly extracted to the test set and one-third to the validation set. Data including age, sex, activity of daily living (ADL), public scales in Japan of ADL “bedriddenness rank,” and cognitive function in daily living, hypnotic medications, previous falls, and emergency admission were derived from hospital records. Falls during hospitalization were identified from incident reports. Two predictive models were created by multivariate analysis, each of which was assessed by area under the curve (AUC) from the validation set.ResultsA total of 7,858 adult participants were available. The AUC of model 1, using 13 factors—age, sex (male), emergency admission, use of ambulance, referral letter, admission to Neurosurgery, admission to Internal Medicine, use of hypnotic medication, permanent damage by stroke, history of falls, visual impairment, independence of eating, and bedriddenness rank—with low mutual collinearity and showing significant relationship by multivariate logistic regression analysis, was 0.789 in the validation set. The AUC of parsimonious model 2, using age and seven factors—sex (male), emergency admission, admission to Neurosurgery, use of hypnotic medication, history of falls, independence of eating, and bedriddenness rank—showing statistical significance by multivariate analysis in model 1, was 0.787 in the validation set.ConclusionsWe proposed new predictive models for inpatients’ fall using the public ADL scales in Japan, which had a higher degree of usability because of their use of simpler and fewer (8 or 13) predictors, especially parsimonious model 2.

Systematic review of the characteristics of brief team interventions to clarify roles and improve functioning in healthcare teams.

Describe brief (less than half a day) interventions aimed at improving healthcare team functioning. A systematic review on brief team interventions aimed at role clarification and team functioning (PROSPERO Registration Number: CRD42018088922). Experimental or quasi-experimental studies were included. Database searches included CINAHL, Medline, EMBASE, PUBMED, Cochrane, RCT Registry-1990 to April 2020 and grey literature. Articles were screened independently by teams of two reviewers. Risk of bias was assessed. Data from the retained articles were extracted by one reviewer and checked by a second reviewer independently. A narrative synthesis was undertaken. Searches yielded 1928 unique records. Final sample contained twenty papers describing 19 studies, published between 2009 and 2020. Studies described brief training interventions conducted in acute care in-patient settings and included a total of 6338 participants. Participants' socio-demographic information was not routinely reported. Studies met between two to six of the eight risk of bias criteria. Interventions included simulations for technical skills, structured communications and speaking up for non-technical skills and debriefing. Debriefing sessions generally lasted between five to 10 minutes. Debriefing sessions reflected key content areas but it was not always possible to determine the influence of the debriefing session on participants' learning because of the limited information reported. Interest in short team interventions is recent. Single two-hour sessions appear to improve technical skills. Three to four 30- to 60-minute training sessions spread out over several weeks with structured facilitation and debriefing appear to improve non-technical skills. Monthly meetings appear to sustain change over time. Short team interventions show promise to improve team functioning. Effectiveness of interventions in primary care and the inclusion of patients and families needs to be examined. Primary care teams are structured differently than teams in acute care and they may have different priorities.

Food intake and oral health status of inpatients with dysphagia in acute care settings.

Adequate oral status and functional assessments are important for dysphagia rehabilitation in acute care inpatient settings, especially to establish individualised oral intake. However, the association between food intake levels and oral function has not been elucidated in acute care inpatients. This cross-sectional study clarified the association between oral intake levels and the oral status/function of patients with dysphagia admitted to acute care settings. Admitted patients aged ≥40years (n=459; men: 288; mean age: 70.8±12.0) examined at the Department of Dysphagia Rehabilitation at the Iwate Medical University Hospital from April 2007 to March 2014 were included. The oral health status was evaluated by the tongue coating, oral dryness severity, plaque control, posterior occlusal support and a repetitive saliva swallowing test (RSST). Dysphagia severity was determined from the Dysphagia Severity Scale. Oral intake levels were evaluated using the Functional Oral Intake Scale (FOIS) at the time of the initial dental examination (FOIS-I), and they were re-evaluated after the revision of levels according to the participants' general condition and oral health status (FOIS-R). Divergence between FOIS-I and FOIS-R was noted in >40% patients. Multiple regression analysis showed significant associations between FOIS-R and consciousness level, activities of daily living, tongue coating, RSST and posterior occlusal support. Patients with dysphagia in acute care settings require detailed assessments of their oral status and function, including swallowing, to determine the most suitable feeding methods and dental interventions to improve oral intake levels.

Considerations and Current Trends in the Management of the Geriatric Patient on a Consultation-Liaison Service.

To provide consultation-liaison psychiatrists with an updated resource that can assist in the treatment and management of geriatric patients. The current available literature has not shown any differences in efficacy between haloperidol and second-generation antipsychotics in patients with delirium. When considering relative advantages of forms of antipsychotic administration, there is no support for a superior safety profile of oral compared to intramuscular or intravenous administration. A recent meta-analysis of four randomized controlled trials concluded that when melatonin was administered to older age patients on medical wards, it significantly prevented the incidence of delirium when compared with the control group. While suvorexant administered nightly to elderly patients in acute care settings may lower the incidence of delirium, larger studies are needed to confirm this finding. Despite the black box warning of increased mortality risk in older patients with dementia, antipsychotics may be used with caution by the consultation-liaison (CL) psychiatrist to treat the neuropsychologic symptoms of dementia including hallucinations and psychosis in the hospital setting. While antidepressant studies have focused primarily on citalopram and escitalopram in the treatment of agitation in the setting of dementia, these two medications have not been adequately compared directly to other SSRIs for this condition. It is therefore not clear whether citalopram and escitalopram are more efficacious in treating agitation in the setting of dementia when compared to other SSRIs. While the evidence supporting trazodone's use is limited, it is generally well tolerated and is an option as a PRN for irritability and agitation in patients with Alzheimer's and mixed dementia. While there is some evidence to support the use of acetylcholinesterase inhibitors for treating cognitive impairments and hallucinations in Lewy body dementia, the usefulness of these agents in other forms of dementia is not well studied, and those studies did not show any benefit in the management of acute agitation. It is important to note that memantine can cause or exacerbate agitation and may be the cause of behavioral dysregulation. There is no evidence to support the routine use of benzodiazepines for behavioral improvement in patients with dementia. Escitalopram and citalopram do have a unique pharmacokinetic properties in the sense that they have been found to have 50-56% plasma protein binding, compared to sertraline, fluoxetine, and paroxetine (95% or more). Pooled analyses suggest that antidepressants are more effective than placebo in reducing the symptoms of post-stroke depression. SSRIs are considered first-line antidepressants in stroke patients, who are often elderly with underlying cardiovascular problems. Although treatment with SSRIs is recommended for post-stroke depression, there are no studies providing conclusive data on the superiority of a specific drug. Older age is associated with a better outcome from ECT, with remission rates of approximately 73% to 90% in patients over 65years. ECT is the treatment of choice for patients with psychotic depression, and elderly patients with psychotic depression have been shown to have a higher remission rate and faster time to response than depressed patients without psychotic symptoms. With the average life expectancy increase, it is projected that 19 million people will reach the age of 85 or higher, an increase from 5.5 million in 2010. With an increasing older population, psychiatric consultation in the management of geriatric patients is becoming more necessary. Psychiatrists must be aware of the unique considerations in elderly patients. In this article, we provide evidence-based guidance to the CL psychiatrist on major issues relating to the older age patient, highlighting recent trends in treatment. First, we provide background on the evaluation of the medically hospitalized geriatric patient. As rates of medical and psychiatric illnesses increase with advancing age, elderly patients are more likely to be taking a higher number of medications as compared to younger patients, and physicians must pay special attention to polypharmacy, including side effects and drug interactions in this group. Next, we focus on the diagnosis, management, and unique needs of the geriatric patient presenting with common clinical syndromes of delirium, dementia, and depression. Delirium and dementia are among the most common causes of cognitive impairment in clinical settings yet are often either unrecognized or misdiagnosed as they may have similar signs and symptoms. In addition, depression is prevalent in older adults, especially in those with comorbid medical illness. Depression can be fatal as the rates of suicide are higher in later life than in any other age group. Consultation can improve the management of elderly patients and prevent unnecessary nursing home placement.

Development and validation of early warning score system: A systematic literature review.

This review aims to: 1) evaluate the quality of model reporting, 2) provide an overview of methodology for developing and validating Early Warning Score Systems (EWSs) for adult patients in acute care settings, and 3) highlight the strengths and limitations of the methodologies, as well as identify future directions for EWS derivation and validation studies. A systematic search was conducted in PubMed, Cochrane Library, and CINAHL. Only peer reviewed articles and clinical guidelines regarding developing and validating EWSs for adult patients in acute care settings were included. 615 articles were extracted and reviewed by five of the authors. Selected studies were evaluated based on the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) checklist. The studies were analyzed according to their study design, predictor selection, outcome measurement, methodology of modeling, and validation strategy. A total of 29 articles were included in the final analysis. Twenty-six articles reported on the development and validation of a new EWS, while three reported on validation and model modification. Only eight studies met more than 75% of the items in the TRIPOD checklist. Three major techniques were utilized among the studies to inform their predictive algorithms: 1) clinical-consensus models (n=6), 2) regression models (n=15), and 3) tree models (n=5). The number of predictors included in the EWSs varied from 3 to 72 with a median of seven. Twenty-eight models included vital signs, while 11 included lab data. Pulse oximetry, mental status, and other variables extracted from electronic health records (EHRs) were among other frequently used predictors. In-hospital mortality, unplanned transfer to the intensive care unit (ICU), and cardiac arrest were commonly used clinical outcomes. Twenty-eight studies conducted a form of model validation either within the study or against other widely-used EWSs. Only three studies validated their model using an external database separate from the derived database. This literature review demonstrates that the characteristics of the cohort, predictors, and outcome selection, as well as the metrics for model validation, vary greatly across EWS studies. There is no consensus on the optimal strategy for developing such algorithms since data-driven models with acceptable predictive accuracy are often site-specific. A standardized checklist for clinical prediction model reporting exists, but few studies have included reporting aligned with it in their publications. Data-driven models are subjected to biases in the use of EHR data, thus it is particularly important to provide detailed study protocols and acknowledge, leverage, or reduce potential biases of the data used for EWS development to improve transparency and generalizability.

Assessment and Management of Pressure Injuries.

Assessment and Management of Pressure Injuries.

The Impact of Hyperoxia in the Critically Ill Patient: A Review of the Literature

Oxygen has long been considered a vital and potentially life-saving component of emergency care. Given this, there is widespread and liberal use of supplemental oxygen in hospitals across the United States and throughout the world. Recent research, however, delineates serious deleterious effects at the cellular level, inducing damage to the cardiovascular system, the central nervous system, the pulmonary system, and beyond. A scoping review was conducted to identify and synthesize available research data as it pertains to the clinical effects of hyperoxia in critically ill adult patients in acute care settings. We searched PubMed, MEDLINE, CINAHL, and Scopus databases. We also reviewed the reference lists of included publications. The selection of relevant articles was conducted by 2 researchers at 2 levels of screening. The review identified 30 studies, of which 5 were randomized controlled trials, 2 were prospective cohort studies, and 23 were retrospective cohort studies. A descriptive analysis of study results was performed. Current evidence suggests an association between hyperoxia and increased mortality after cardiac arrest, stroke, and traumatic brain injury, as well as in the setting of sepsis, although there is insufficient evidence to conclude concretely that hyperoxia effects clinical outcomes. As such, there exists a need for additional large-scale randomized controlled trials with well-defined parameters for the evaluation of clinical outcomes. Until the completion of such trials, titration of supplemental O2 to normoxia is advised to avoid the negative effects of both hyperoxia and hypoxia in acutely ill adult patients.

Deterioration to decision: a comprehensive literature review of rapid response applications for deteriorating patients in acute care settings

Early detection of clinical deterioration and timely escalation are critical for improving patient safety and preventing subsequent events in hospitals/acute care settings. This paper reviewed existing Rapid Response Systems (RRS) and their applications that incorporate Early Warning Score (EWS) for escalating patient deterioration and rapid response. We identified and analysed response applications and key factors impacting on ward nurses’ ability to recognise and respond to patients deterioration. The literature reports comprise of adoption of various EWS protocols, communication policies, and educational strategies to the specialised healthcare team that have been introduced in the acute care settings to improve patient deterioration workflow. It was found that there are gaps and limitations at different stages of RRS from vital signs collection to escalation and response. Currently, there is no single solution available for clinicians to adopt an efficient escalation workflow. Therefore, there is a clear need for a connected, integrated, user-friendly and effective solution for collection of vital signs to timely escalation and response. Finally, we discussed key gaps and limitations of RRS with future direction and recommendations.

Pro Re Nata Medication Use in Acute Care Adolescent Psychiatric Unit.

Objective: Evidence to support the use of pro re nata (PRN) medication is limited, and the details of PRN use (indication, frequency of administration, patient characteristics) are rarely reported, particularly in youth populations. The goal of this study was to report on the pattern of PRN use over 6 years in an acute care psychiatric unit for adolescents. Methods: A retrospective chart review of patients' records from November 2012 to October 2018 was conducted. Variables extracted from electronic medical records included age, gender, race/ethnicity, clinical rating scores at admission (on a subset of patients), length of stay, psychotropic and nonpsychotropic PRN medication administration, timing of administration, discharge diagnosis, and discharge medication. Results: Records from 2961 individuals with a total 3937 admissions were analyzed. A total of 62% of admissions had at least one PRN medication administration. Severity of symptoms, as indicated by higher scores on clinical rating scales at admission, longer length of stay, and readmission were related to high PRN use. Patients with bipolar spectrum disorders received more psychotropic and nonpsychotropic PRN medications than other patients. Patients who were high psychotropic PRN users were also high nonpsychotropic PRN users. Conclusion: Despite the lack of clear evidence in support of the efficacy of PRN medications, they commonly used to control symptoms in acute care inpatient settings. Youth with severe symptoms utilized not only psychotropic PRN medication but also nonpsychotropic PRN more frequently, suggesting a possible role of systemic disorder among youth with serious mental illness. More research is necessary to examine the efficacy of PRN medications for managing targeted symptoms.

Novice RNs' Lived Experience Providing End-of-Life Care: A Hermeneutic Phenomenology

This hermeneutic study explored the lived experience of novice RNs who care for dying patients in acute care settings to understand to meaning of their experience. Fourteen novice RNs participated in individual telephone semi-structured interviews. Transcripts were analyzed using Colaizzi's method. Results obtained were based on the hermeneutic circle. The findings identified 3 major themes: (a) obstacles in end-of-life care; (b) personal response; and (c) coping strategies and 12 subthemes. Despite the obstacles in care, compassionate care was provided that resulted in professional growth.

Effect of telemonitoring on self-care behaviors among community-dwelling adults with heart failure: a quantitative systematic review protocol.

This systematic review seeks to synthesize evidence to determine the effect of telemonitoring on self-care behaviors of adults with heart failure. There is a high-level body of evidence demonstrating that telemonitoring is an appropriate and effective therapy for many chronic conditions and, specifically, for patients with heart failure. However, the effect of telemonitoring on self-care behaviors in the adult population with heart failure is unknown. This review will include studies on adult participants (18 years and over) diagnosed with heart failure who use telemonitoring in the ambulatory setting. Studies of pediatric heart failure patients, and adult heart failure patients in acute care settings or in a care facility, will be excluded. The search for studies will include English language studies published from 1997. Search terms will include heart failure, telemonitoring, self-care, and outpatient/ambulatory care, and will be used in three key sources: CINAHL, Embase, and PubMed. For the full review, Epistomonikos, ProQuest, PsycINFO, and Web of Science will also be searched. Using inclusion/exclusion criteria, two reviewers will select studies based on a three-step process. Methodological quality will be determined using critical appraisal checklists appropriate to the study design. Data extraction will include populations, study designs and methods, interventions, and outcomes related to self-care behaviors. Pooled studies will allow calculation of meta-analysis, while calculated effect sizes and confidence intervals will inform impact and precision of effect. PROSPERO CRD42019131852.

Development and Comparison of Predictive Models for Pressure Injuries in Surgical Patients: A Retrospective Case-Control Study.

The purpose of this study was to develop and compare 3 predictive models for pressure injury (PI) occurrence in surgical patients. Retrospective case-control study. Data on PI risk assessment and preanesthesia evaluation records from 400 patients (80 patients who developed PIs after surgery and 320 patients who did not) in a South Korean acute care setting who underwent surgery between January 2015 and May 2016 were extracted from the electronic health record. Three models were developed with items from the Braden Scale (model 1), the Scott Triggers tool (model 2), and the Scott Triggers tool in addition to type of anesthesia, laboratory test results, and comorbid conditions (model 3) using logistic regression to analyze items (factors) in each model. Predictive performance indices, which included sensitivity, specificity, positive predictive value, negative predictive value, area under the receiver operating characteristics curve, and Akaike information criterion, were compared among the 3 models. Findings showed there were no significant factors in model 1, the estimated surgery time and serum albumin level were significant in model 2, and the estimated surgery time, serum albumin level, and brain disease were significant in model 3. The model performance evaluation revealed that model 2 was the best fitting model, demonstrating the highest sensitivity (84.4%), highest negative predictive value (94.6%), and lowest Akaike information criterion (302.03). The Scott Triggers tool in model 2, which consists of simple items that are easy to extract from preanesthesia evaluation records, was the best fitting model. We recommend the Scott Triggers tool be used to predict the development of PIs in surgical patients in acute care settings.

A pilot study to investigate the feasibility of the modified Blaylock Tool for Occupational Therapy Referral (MBTOTR) for use by nurses in acute care

Purpose Patients in acute care settings may have limitations in their functional capacity associated with multiple morbidities. Occupational therapy can address factors affecting functional decline, and early and accurate identification of patients requiring occupational therapy referral can facilitate safe discharge. This study aimed to investigate the feasibility of the Modified Blaylock Tool for Occupational Therapy Referral to identify the characteristics of patients who would potentially require occupational therapy referral, for use by acute care nurses. Methods A cross-sectional study was conducted using mixed methods. The Modified Blaylock Tool for Occupational Therapy Referral was completed for 305 patients by six acute care nurses across three clinical areas in an acute hospital setting. Data were analyzed using descriptive and non-parametric statistics. Semi-structured interviews were then conducted with these six nurses to understand their perspectives of their use of the Modified Blaylock Tool for Occupational Therapy Referral. Results Nearly half (45%) of the assessed patients had Modified Blaylock Tool for Occupational Therapy Referral scores recommending occupational therapy referral. Items associated with risk of functional decline were mobility, memory and recent hospital admissions. Barriers to referral included resource limitations, lack of visibility, poor understanding of occupational therapy and lack of holistic assessment of patients. Conclusion The Modified Blaylock Tool for Occupational Therapy Referral could be used by nurses to identify acute care patients at risk of functional decline. Future research should include larger and longitudinal studies to validate the Modified Blaylock Tool for Occupational Therapy Referral further. Implications for rehabilitation The Modified Blaylock Tool for Occupational Therapy Referral could be used by nurses to identify acute care patients at risk of functional decline. This allows the early and accurate identification of patients requiring occupational therapy referral to facilitate safe discharge from acute care.

Impact of Successful Implementation of an Antimicrobial Stewardship Program in an Inpatient Rehabilitation Setting

BACKGROUND Antimicrobial stewardship in any setting is vital to organizational performance measures, as well as to meeting National Patient Safety Goals. Antimicrobial resistance causes about 23,000 deaths per year and about 250,000 cases of hospital-onset Clostridium difficile (C.diff) each year. This study was designed to determine if successful implementation of an antimicrobial stewardship program (ASP) would help in reducing the treatment of asymptomatic bacteriuria in the acute care inpatient rehabilitation setting to reduce overall antimicrobial use. METHODS This study was a confirmatory research process. We included all patients admitted to the inpatient rehabilitation facility during the study period from January 2017 through October 2018. Data was based on the National Healthcare Safety Network (NHSN) approved signs or symptoms. Education was provided to all clinical and medical staff. Data was collected monthly to determine what areas still needed attention until all aspects of the ASP were implemented successfully. RESULTS Initially, rates averaged around 79% of patients unnecessarily treated for asymptomatic bacteriuria. The study observed 2,591 patients admitted over a period of 22 months, during which we were able to reduce our erroneously treated asymptomatic patients to 0%. Medical staff are only utilizing NHSN definitions to treat patients if needed, staff are only looking for NHSN signs and symptoms to report to physicians, and overall days of therapy have been greatly reduced. CONCLUSIONS Implementation of an ASP reduces the overall use of antimicrobials with continued education and organizational support. Lower antimicrobial usage rates reduce the occurrence of hospital-onset C.diff infections and prevent long-term effects such as antimicrobial resistance. Facilities of all types may want to consider implementing ASP programs to reduce antimicrobial usage rates and to ensure patient safety. Antimicrobial stewardship in any setting is vital to organizational performance measures, as well as to meeting National Patient Safety Goals. Antimicrobial resistance causes about 23,000 deaths per year and about 250,000 cases of hospital-onset Clostridium difficile (C.diff) each year. This study was designed to determine if successful implementation of an antimicrobial stewardship program (ASP) would help in reducing the treatment of asymptomatic bacteriuria in the acute care inpatient rehabilitation setting to reduce overall antimicrobial use. This study was a confirmatory research process. We included all patients admitted to the inpatient rehabilitation facility during the study period from January 2017 through October 2018. Data was based on the National Healthcare Safety Network (NHSN) approved signs or symptoms. Education was provided to all clinical and medical staff. Data was collected monthly to determine what areas still needed attention until all aspects of the ASP were implemented successfully. Initially, rates averaged around 79% of patients unnecessarily treated for asymptomatic bacteriuria. The study observed 2,591 patients admitted over a period of 22 months, during which we were able to reduce our erroneously treated asymptomatic patients to 0%. Medical staff are only utilizing NHSN definitions to treat patients if needed, staff are only looking for NHSN signs and symptoms to report to physicians, and overall days of therapy have been greatly reduced. Implementation of an ASP reduces the overall use of antimicrobials with continued education and organizational support. Lower antimicrobial usage rates reduce the occurrence of hospital-onset C.diff infections and prevent long-term effects such as antimicrobial resistance. Facilities of all types may want to consider implementing ASP programs to reduce antimicrobial usage rates and to ensure patient safety.

Activity Measure for Post Acute Care “Clicks”: Activity and Cognitive Scores Are Associated With Acute Care Discharge to Home

Abstract Date Presented 4/22/2018 The Activity Measure for Post Acute Care (AM-PAC) “Clicks” tools are used to assess function of patients in acute care settings. This study tested the association between the stages of the AM-PAC activity and cognitive scores and discharge to home. Results show that higher scores were associated with discharge to home. Primary Author and Speaker: Adam Porter Contributing Authors: Joshua Johnson, Christopher Noren, Lori Richards

Correlation of Bedside Pediatric Early Warning System Score to Interventions During Peritransport Period.

The Bedside Pediatric Early Warning System score is a validated measure of severity of illness in acute care inpatient settings. Its potential as a remote assessment tool for interfacility transport has not been evaluated. We hypothesized that the Bedside Pediatric Early Warning System score was associated with need for intervention during the peritransport period and patient disposition. We retrospectively evaluated children transported by a regional pediatric team during a 6-month period. Bedside Pediatric Early Warning System scores were calculated at the triage phone call, the transport team arrival, and at transfer of care to the hospital team. The primary outcome was the receipt of significant intervention during the peritransport period, with additional outcomes of destination (ICU, ward, emergency department) in the regional hospital. Scores are presented as median values (interquartile range). There were 564 children who underwent transport; 139 (25%) received interventions; and 205 (36%) were transferred to the PICU, 231 (41%) to the ward, and 127 (23%) to the emergency department. Scores were 2 (1-5; median interquartile range) in children receiving no in-transport interventions, 8 (5-11) in children receiving any intervention (p < 0.001), and 10 (7-14) in children receiving more than one intervention. Children transferred to the PICU had higher scores 6 (3-10), than children transferred to a ward 3 (1-6) or the emergency department 2 (1-3) (p < 0.001). The Bedside Pediatric Early Warning System score at the time of initial referral is a useful measure of severity of illness reflected by the subsequent provision of significant peritransport intervention and the transfer destination.

Ogroženost za padce v terciarni bolnišnici

Uvod: Namen raziskave je bil ugotoviti, kakšna je ogroženost za padce odraslih pacientov v akutni zdravstveni obravnavi ter kakšne so razlike v ogroženosti glede na spol, starost, kraj pacientove obravnave (kliniko) in specialnost stroke ter kategorijo zahtevnosti bolnišnične zdravstvene nege.Metode: Uporabljeno je bilo kvantitativno raziskovanje – presečna opazovalna raziskava. Vzorec (n = 1361) je vključeval odrasle paciente, hospitalizirane v Univerzitetnem kliničnem centru Ljubljana. Podatki so se zbirali na za to posebej razvitem instrumentu, pri čemer je bila ogroženost za padce vrednotena z Morsejino lestvico. Podatki so se zbirali od oktobra do novembra 2015. Poleg osnovne deskriptivne statistike so bili uporabljeni tudi Mann-Whitneyjev test, test ANOVA in Pearsonov korelacijski test.Rezultati: Raziskava je pokazala, da je v akutni zdravstveni obravnavi v slovenski terciarni bolnišnici zmerno do visoko ogroženih za padce 69,1 % (n = 940) pacientov, od tega je 28,0 % (n = 381) visoko ogroženih. Ogroženost pacientov za padce je pozitivno povezana s starostjo (r = 0,462, p &lt; 0,001). Razlikuje se tudi glede na kliniko (F = 29,210, p &lt; 0,001), specialnost stroke (Z = –5,660, p &lt; 0,001) ter kategorijo zahtevnosti zdravstvene nege (F = 125,464, p &lt; 0,001).Diskusija in zaključek: Pomembno bolj ogroženi so starejši, pacienti, razvrščeni v višje kategorije zahtevnosti bolnišnične zdravstvene nege, ter pacienti, zdravljeni v okviru internističnih strok. Rutinsko ocenjevanje ogroženosti, načrtovanje in izvajanje ukrepov za preprečevanje padcev so temelji zmanjševanja padcev.

Approach to initiating QT-prolonging oncology drugs in the ambulatory setting.

Since the introduction of regulatory drug approval guidance on the evaluation of QT interval prolongation, an increasing number of drug monographs has included cautions on the risk of QT prolongation. For example, QT prolongation is mentioned in the Canadian product monographs of 29 drugs commonly seen in oncology practice. This presents two major challenges. First, most guidelines and risk predictive tools for QT prolongation have been developed for hospitalized patients in acute care settings. In contrast, most QT-prolonging oncology drugs are used in medically stable patients in the ambulatory setting. Second, many oncology drugs are unique for their indications and non-QT prolonging alternative agents are often not available. In this review, we will outline an empiric initial approach to ambulatory cancer patients who are treated with oncology drugs which may prolong QT interval. This includes the predictive value of QT prolongation on torsades de pointes, the risk factors of the patients and the drugs, and the limitations of existing guidance in this area.